HomeMy WebLinkAboutBuilding Permit Application All APPLI RLE INFO MUST BE•COMPLETEV FOR APPLICATION TO BE ACCEPTED
Date: 1 J Permit Number:
4
RECEIVED
Building Permit Application APR 2 2 2019
Planning and 0evelopmen t Services
Building and code Regulation Division
2300 Virginia Avenue,Fart Pierce 1=L 34982 ST. Lucie County, Permitting
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE: Whom ccU
Address: E511-3 Qn M Dr We_FJDr+._2 tier a r—L !I 97
Property Tax ID M. 5u02-- 1002 - 03-32 + QM_ 5 Lot No. 2
Site Plan Name: Block No. tAq -.-
Project Name:
ZJ
ahfi
191
P
Additionalwork to be performed under this permit-check all that apply:
KMethanical _Gas Tank Gas Piping _Shutters —Windows/Doors
_Electric ^Plumbing Sprinklers —Generator _Roof Pitch
Total Sq.Vt of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ U C) Utilities: —Sewer _Septic Building Height:
1:11111 11112
Name n r Name:s " r fd W
Address: r1 Company:
City.. F-br•- Qlfr(C ' - State:. Address: 5aDD —
Zip Code 2- Fax: City: State:_Fll
Phone No. - zip Cade:_ —_ fax -1 _520-52Fill in fee simple Title Holder on next page(if different E-Mail PC
from the Owner listed above) State or County License
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement Is required.
Iffli 1:1111
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: _ Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name; Name:
Address: Address:
City: City:_
Zip: Phone: zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
(certify that no work or Installation has commenced prior to the issuance of a permit.
St.Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,1 do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools;fences,walls,signs,screen rooms and accessory uses to another nonresidential use
"`WARNING TO OWNER, YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNIEY.BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
1gnature of Owner/Lessee/Contractor as Agent for Owner ignature of Contractor/License Holder
STATE OF FLORIPA STATE OF FLORI .
.COUNTY OF UV'CMQ& COUNTY OF
The-fo oing instru ent was acknowledge efore me The fo oing instr ent was acknowledg before me
this day of 20�by this day of 216&, by .
S�1P.rY't�G� l �tr1 �l
Marne of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Knownd OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-Stat S (Signature of Nota .P WES
+ � CILLANI
Commission No. °j' +i'• # �T Commission fV
MIMS. �
.�e PubG�
REVIEWS. FRUITF ZONING SUPERVISOR PLANS VE ATION SEA TURTLE' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED'
DATE
COMPLETED
Rev.